TITLE 12. HEALTH

STATE BOARD OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES

Fast-Track Regulation

Titles of Regulations: 12VAC35-190. Regulations for Voluntary Admissions to State Training Centers (repealing 12VAC35-190-10, 12VAC35-190-21, 12VAC35-190-30, 12VAC35-190-41, 12VAC35-190-51).

12VAC35-200. Regulations for Emergency and Respite Care Admission to State Training Centers (amending 12VAC35-200-10, 12VAC35-200-20; adding 12VAC35-200-35, 12VAC35-200-45, 12VAC35-200-50, 12VAC35-200-55; repealing 12VAC35-200-30).

Statutory Authority: §§ 37.2-203 and 37.2-807 of the Code of Virginia.

Public Hearing Information: No public hearing is currently scheduled.

Public Comment Deadline: November 20, 2024.

Effective Date: December 5, 2024.

Agency Contact: Ruth Anne Walker, Director of Regulatory Affairs, Department of Behavioral Health and Developmental Services, Jefferson Building 1220 Bank Street, Fourth Floor, Richmond, VA 23219, telephone (804) 225-2252, FAX (804) 371-4609, TDD (804) 371-8977, or email ruthanne.walker@dbhds.virginia.gov.

Basis: Section 37.2-203 of the Code of Virginia authorizes the State Board of Behavioral Health and Developmental Services to promulgate regulations that may be necessary to carry out the provisions of Title 37.2 and other laws of the Commonwealth administered by the Department of Behavioral Health and Developmental Services (DBHDS) or its commissioner.

Purpose: Even with a dramatic reduction in training center admissions, as long as the Commonwealth continues to provide training center services, a regulation is needed to address admission procedures. The purpose of this regulatory action is to bring all regulatory language pertaining to admissions to DBHDS training centers into one regulatory chapter to provide clarity and ease of use. Also, amendments are made to reflect current admissions practices. The streamlining of the regulatory language for clarity and the update for current practices help to ensure the health, safety, and welfare of individuals needing services by facilitating staff understanding of the processes for efficient delivery of services.

Rationale for Using Fast-Track Rulemaking Process: This action is noncontroversial because it is merely combining existing language in two chapters into one for ease of use regarding training center admissions. No part of the code-mandated process or regulatory process is removed. There is only one substantive change in the hours for consideration of an emergency admission, and that is a reflection of current practice for the past several years.

Substance: This action merges two chapters into one through amendments to Chapter 200 and the repeal of Chapter 190 in order to provide clarity and ease of use. Specifically, the definition of respite care is removed as any respite admissions only occur for situations that are emergencies, and thus are captured under the definition of an emergency admission. Current practices are reflected to demonstrate that (i) during the application process, the community service board (CSB) consults with DBHDS and makes a referral to the regional support team (RST) requesting an emergency meeting, and the CSB is expected to pursue all recommendations made by the RST, consulting with the department and requesting an emergency admission to the training center only after it is determined that emergency admission is still necessary; (ii) the response time for the department to let the CSB know if the admission is accepted is changed from 24 hours to 72 hours, which provides time for part-time psychiatric staff consultation with the interdisciplinary team to review all documentation and thoroughly evaluate the request; and (iii) the CSB shall work with the DBHDS community integration managers and training center staff to develop a discharge plan after emergency admission as provided in §§ 37.2-505 and 37.2-837 of the Code of Virginia.

Issues: The primary advantage of this action to the public is that it brings all regulatory language pertaining to admissions to DBHDS training centers into one regulatory chapter to provide clarity and ease of use by individuals needing or receiving training center services and the authorized representatives of those individuals. As the action does not add additional burden or remove protections for individuals, there are no disadvantages to the public. The primary advantage to the Commonwealth is that the regulatory language is reflective of current practice and all admissions language is in one chapter. There are no disadvantages to the Commonwealth.

Department of Planning and Budget's Economic Impact Analysis:

The Department of Planning and Budget (DPB) has analyzed the economic impact of this proposed regulation in accordance with § 2.2-4007.04 of the Code of Virginia and Executive Order 19. The analysis presented represents DPB's best estimate of the potential economic impacts as of the date of this analysis.¹

Summary of the Proposed Amendments to Regulation. As the result of a periodic review² and Executive Directive 1 (2022)³ the State Board of Behavioral Health and Developmental Services (board) has adopted a fast-track rulemaking action to merge 12VAC35-190 into 12VAC35-200, and repeal 12VAC35-190, in order to streamline and clarify the regulation; other changes would update the regulation to reflect current practice.

Background. State training centers are a type of residential facility operated by the Department of Behavioral Health and Developmental Services (DBHDS) that provides highly structured habilitation services, including life in a residential neighborhood, care support or training, and learning opportunities in areas such as employment, communication, language, self-care, independent living, socialization, recreation, leisure, music, academic skills, and motor development for individuals with intellectual and developmental disabilities. This regulatory action combines two existing regulatory chapters that address admissions to state training centers by repealing Regulations for Voluntary Admissions to State Training Centers (12VAC35-190) and amending Regulations for Emergency and Respite Care Admission to State Training Centers (12VAC35-200) to incorporate most of the language from 12VAC35-190 in order to streamline the regulation; other changes would update regulatory language to reflect current practice. DBHDS reports that as a result of the U.S. Department of Justice Settlement Agreement with Virginia,⁴ the expansion of intellectual and developmental disability waiver slots, and increased rates of service for private providers, respite service for nonemergent care has not been utilized at training centers for several years.⁵ DBHDS also reports that training center admission is rarely a part of "emergency need" discussions due to increased community capacity and other improvements within the service system that make it easier to meet emergency residential needs. As a result, there was one respite or emergency admission to a state training facility in 2017 and four in 2018 (four of these five admissions in 2017-2018 were for the same individual); no respite or emergency admissions have occurred since that time.⁶ Further, while there used to be five state training centers, since April 2020 there has been only one training center, the Southeastern Virginia Training Center located in Chesapeake.⁷ To reflect these changes, the title of the combined 12VAC35-200 would be changed to "Regulations for Voluntary and Emergency Admission to State Training Centers." References to respite care (short-term relief for primary caregivers) would be removed from the title and the regulatory text because, in practice, such admissions only occur in emergency situations.⁸ 12VAC35-200-20 and 12VAC35-200-30, which address applications for respite care admissions and emergency admissions, respectively, would be substantively combined under the new 12VAC35-200-45 A. 12VAC35-200-20 would be retitled "Requests for Admission" and amended to state that all (emergency and voluntary) requests for admission to a training center shall be processed through the community services board (CSB) and that the CSB must consult with DBHDS, make a referral to the regional support team (RST), and follow up on all recommendations made by the RST. The current text does not involve DBHDS and directs CSBs to consult with the RST; this change reflects current practice, which has evolved to direct placements toward the least restrictive settings that could sufficiently meet the individual needs. This change is reiterated for emergency admissions in the new 12VAC35-200-45 A and for voluntary admissions under 12VAC35-200-45 B. The new 12VAC35-200-45 A also differs from the requirements currently in 12VAC35-200-30 by increasing the response time for DBHDS to notify the CSB if an emergency admission is accepted from "within 24 hours" to "as quickly as possible but no later than 72 hours." DBHDS reports that this change would address the use of part-time psychiatric staff by providing them time to consult with the interdisciplinary team, review all documentation, and thoroughly evaluate the request. For instance, this change would give the training center staff adequate time to receive all the documentation for a request made on a Friday, and then make a decision by the following Monday. In addition, DBHDS reports that designated staff work closely with the CSBs to provide guidance and support with identifying resources needed to ensure the provision of appropriate care and services for individuals, including those who may be in need of emergency placement. That staff would be a part of those discussions and able to communicate with all stakeholders if someone was at imminent risk of harm and the 72-hour timeframe would jeopardize health and safety. Other changes to 12VAC35-200 include adding a definition for the term "community integration manager" or "CIM" to reference the DBHDS central office position physically located at the one remaining training center. This position provides support and direction for all aspects of the individual's transition to the community including addressing identified barriers to discharge. 12VAC35-200-45 A would include a requirement that, "If for any reason a person admitted to a training center for emergency services is not discharged at the agreed upon time, the CSB shall work with the CIM and training center staff to develop a discharge plan as provided in §§ 37.2-505 and 37.2-837 of the Code of Virginia." In merging 12VAC35-190 into 12VAC35-200, a definition of "licensed professional" currently in 12VAC35-190 would also be added to the definitions in 12VAC35-200, and the requirements for application for voluntary admission in 12VAC35-200-21 would be added to 12VAC35-200-45 B.⁹ 12VAC35-200-45 B would contain one new requirement that the preadmission screening report for voluntary admission include, "A statement from the CSB that the appropriate arrangements are being made to work with the individual and the family member or authorized representative to continue exploring opportunities to discharge the individual to a less restrictive setting." Lastly, 12VAC35-190-30 (Criteria for admission), 12VAC35-190-41 (Requests for reconsideration of the director's determination), and 12VAC35-190-51 (Judicial certification) would be added as 12VAC35-200-35, 12VAC35-200-50, and 12VAC35-200-55, respectively.

Estimated Benefits and Costs. The proposed amendments would benefit families and caregivers, and their representatives, by streamlining the regulation, removing redundant language, and reflecting changes to current practice, which were implemented to enable placements in the least restrictive community settings. On the other hand, individuals or families seeking emergency placement at a training center may experience a longer wait time for a determination from the training center, from 24 hours to 72 hours, which could result in costs to them as they may have to provide more intensive or expensive care at home. However, such costs would be mitigated by CSB ability to place individuals in settings other than the training center, possibly sooner. This growth in the capacity for community placement, even for emergency and respite care, is evidenced by the lack of such placements at a training center since 2019. CSB staff could face a modest increase in their workload from (i) coordinating with DBHDS and the RST in response to a request for emergency or voluntary admission, (ii) working with the CIM to develop a discharge plan for emergency admissions who are not discharged at the agreed upon time, and (iii) working on discharging voluntary admissions to a less restrictive setting, as required by the additional statement to be included in the preadmission screening report. However, to the extent that the proposed changes reflect current practice, these costs are likely already being incurred.

Businesses and Other Entities Affected. As described, the proposed changes would primarily affect individuals and their caregivers seeking emergency or voluntary admission to a training center. The Code of Virginia requires DPB to assess whether an adverse impact may result from the proposed regulation.¹⁰ An adverse impact is indicated if there is any increase in net cost or reduction in net benefit for any entity, even if the benefits exceed the costs for all entities combined.¹¹ Because the proposed amendments could potentially result in a longer wait time for emergency admission to a training center, which could result in costs for affected families, an adverse impact is indicated. However, as noted, such costs would be mitigated by the investments in community placement options that have already been made.

Small Businesses¹² Affected.¹³ The proposed amendments would not adversely affect small businesses.

Localities¹⁴ Affected.¹⁵ No locality would be disproportionately affected. Local governments would not incur new costs.

Projected Impact on Employment. The proposed regulation does not appear to affect total employment.

Effects on the Use and Value of Private Property. The proposed amendments do not appear to affect the value of private property. Real estate development costs would not be affected.

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¹ Section 2.2-4007.04 of the Code of Virginia requires that such economic impact analyses determine the public benefits and costs of the proposed amendments. Further the analysis should include but not be limited to: (1) the projected number of businesses or other entities to whom the proposed regulatory action would apply, (2) the identity of any localities and types of businesses or other entities particularly affected, (3) the projected number of persons and employment positions to be affected, (4) the projected costs to affected businesses or entities to implement or comply with the regulation, and (5) the impact on the use and value of private property.

² See the periodic review associated with 12VAC35-190 here: https://townhall.virginia.gov/L/ViewPReview.cfm?PRid=2076. See also the periodic review associated with 12VAC35-200: https://townhall.virginia.gov/L/viewpreview.cfm?PRID=2077.

³ ED 1, which was issued on January 15, 2022, directs executive branch agencies "to initiate regulatory processes to reduce by at least 25% the number of regulations not mandated by federal or state statute. See https://www.governor.virginia.gov/media/governorvirginiagov/governor-of-virginia/pdf/ed/ED-1-Regulatory-Reduction.pdf. ED 1 was subsequently amended and reenacted by Executive Order 19 (2022) to "require a 25% reduction in regulatory requirements instead of a reduction in regulations." See https://townhall.virginia.gov/EO-19-Development-and-Review-of-State-Agency-Regulations.pdf.

⁴ See https://dbhds.virginia.gov/doj-settlement-agreement/ for background information.

⁵ See page 1 of the Economic Review Form: https://townhall.virginia.gov/L/GetFile.cfm?File=65\ 6286\10076\ORM_EconomicImpact_DBHDS_10076_v3.pdf.

⁶ DBHDS further reports that only two emergency requests have been received since 2020 and they were both denied in favor of alternative placements because the leadership team determined that the training center was not an appropriate residential option to meet their care and support needs.

⁷ See https://dbhds.virginia.gov/about-dbhds/facilities/.

⁸ See page 3 of the Agency Background Document (ABD): https://townhall.virginia.gov/L/GetFile.cfm?File=65\6286\10076\AgencyStatement_DBHDS_10076_v2.pdf.

⁹ This language here would be similarly updated as for 12VAC35-200-45 A. to require CSBs to consult with DBHDS and make a referral to the RST, specifying that, "The CSB shall pursue all recommendations made by the RST. If it is determined that a voluntary admission is still necessary, the CSB shall consult with the department and request an admission to the training center."

¹⁰ Pursuant to § 2.2-4007.04 D: In the event this economic impact analysis reveals that the proposed regulation would have an adverse economic impact on businesses or would impose a significant adverse economic impact on a locality, business, or entity particularly affected, the Department of Planning and Budget shall advise the Joint Commission on Administrative Rules, the House Committee on Appropriations, and the Senate Committee on Finance. Statute does not define "adverse impact," state whether only Virginia entities should be considered, nor indicate whether an adverse impact results from regulatory requirements mandated by legislation.

¹¹ Statute does not define "adverse impact," state whether only Virginia entities should be considered, nor indicate whether an adverse impact results from regulatory requirements mandated by legislation. As a result, DPB has adopted a definition of adverse impact that assesses changes in net costs and benefits for each affected Virginia entity that directly results from discretionary changes to the regulation.

¹² Pursuant to § 2.2-4007.04, small business is defined as "a business entity, including its affiliates, that (i) is independently owned and operated and (ii) employs fewer than 500 full-time employees or has gross annual sales of less than $6 million."

¹³ If the proposed regulatory action may have an adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include: (1) an identification and estimate of the number of small businesses subject to the proposed regulation, (2) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the proposed regulation, including the type of professional skills necessary for preparing required reports and other documents, (3) a statement of the probable effect of the proposed regulation on affected small businesses, and (4) a description of any less intrusive or less costly alternative methods of achieving the purpose of the proposed regulation. Additionally, pursuant to § 2.2-4007.1 of the Code of Virginia, if there is a finding that a proposed regulation may have an adverse impact on small business, the Joint Commission on Administrative Rules shall be notified.

¹⁴ "Locality" can refer to either local governments or the locations in the Commonwealth where the activities relevant to the regulatory change are most likely to occur.

¹⁵ Section 2.2-4007.04 defines "particularly affected" as bearing disproportionate material impact.

Agency's Response to Economic Impact Analysis: The Department of Behavioral Health and Developmental Services concurs with the economic impact analysis prepared by the Department of Planning and Budget.

Summary:

As a result of periodic review, the amendments (i) repeal Regulations for Voluntary Admissions to State Training Centers (12VAC35-190) and move some provisions from 12VAC35-190 into 12VAC35-200; (ii) change the application process so that the community service board (CSB) consults with the Department of Behavioral Health And Developmental Services (department) and makes a referral to the regional support team (RST) requesting an emergency meeting, and the CSB is expected to pursue all recommendations made by the RST, consulting with the department and requesting an emergency admission to the training center only after it is determined that emergency admission is still necessary; (iii) increase to 72 hours the amount of time the department has to let the CSB know if the admission is accepted, which provides time for part-time psychiatric staff, in consultation with the interdisciplinary team, to review all documentation and thoroughly evaluate the request; and (iv) require that the CSB work with the department's community integration managers and training center staff to develop a discharge plan after emergency admission.

Chapter 200

Regulations for Voluntary and Emergency and Respite Care Admission to State Training Centers

12VAC35-200-10. Definitions.

The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:

"Admission" means acceptance of an individual in a training center.

"Authorized representative" or "AR" means a person permitted by law or regulations regulation to authorize the disclosure of information or to consent to treatment and services or participation in human research.

"Commissioner" means the Commissioner of the Department of Behavioral Health and Developmental Services.

"Community integration manager" or "CIM" means the DBHDS Central Office position physically located at the training center that is responsible for coordinating the implementation of policies, procedures, regulations, and other initiatives related to ensuring that each individual residing in a training center is served in the most integrated setting appropriate to meet the individual's needs and desires. This position provides support and direction for all aspects of the individual's transition to the community, including addressing identified barriers to discharge.

"Community services board" or "CSB" means a public body established pursuant to § 37.2-501 of the Code of Virginia that provides mental health, developmental, and substance abuse services to individuals within each city and county that established it. For the purpose of this chapter, CSB also includes a behavioral health authority established pursuant to § 37.2-602 of the Code of Virginia.

"Department" or "DBHDS" means the Department of Behavioral Health and Developmental Services.

"Discharge plan" means a written plan prepared by the CSB providing case management, in consultation with the training center pursuant to §§ 37.2-505 and 37.2-837 of the Code of Virginia. This plan is prepared when the individual is admitted to the training center and documents the services to be provided upon discharge.

"Emergency admission" means the temporary acceptance of an individual with an intellectual disability into a training center when immediate care is necessary and no other community alternatives are available.

"Guardian" means:

1. For minors --, an adult who is either appointed by the court as a legal guardian of a minor or exercises the rights and responsibilities of legal custody by delegation from a biological or adoptive parent upon provisional adoption or otherwise by operation of law.

2. For adults --, a person appointed by the court who is responsible for the personal affairs of an incapacitated adult under the order of appointment. The responsibilities may include making decisions regarding the individual's support, care, health, safety, habilitation, education, and therapeutic treatment. Refer to definition of "incapacitated person" at § 64.2-2000 of the Code of Virginia.

"Individual" means a person with an intellectual disability for whom services are sought. This term includes the terms "consumer," "patient," "resident," and "client."

"Intellectual disability" means a disability originating before the age of 18 years, characterized concurrently by (i) significant subaverage intellectual functioning as demonstrated by performance on a standardized measure of intellectual functioning administered in conformity with accepted professional practice that is at least two standard deviations below the mean and (ii) significant limitations in adaptive behavior as expressed in conceptual, social, and practical adaptive skills.

"Less restrictive setting" means the service location that is no more intrusive or restrictive of freedom than reasonably necessary to achieve a substantial therapeutic benefit and protection from harm (to self and others) based on an individual's needs.

"Licensed professional" means a licensed psychologist, licensed professional counselor, or other individual who holds a valid professional license and has appropriate training in intellectual testing.

"Regional support team" or "RST" means a group of professionals with expertise in serving individuals with developmental disabilities in the community appointed by the commissioner or the commissioner's designee who provide recommendations to support placement in the most integrated setting appropriate to an individual's needs and consistent with the individual's informed choice.

"Respite care" means care provided to an individual with an intellectual disability on a short-term basis because of the emergency absence of or need to provide routine or periodic relief of the primary caregiver for the individual. Services are specifically designed to provide temporary, substitute care for that which is normally provided by the primary caregiver.

"Training center" means a facility operated by the department that provides training, habilitation, or other individually focused supports to persons with intellectual disabilities.

12VAC35-200-20. Respite care admission Requests for admission.

A. Applications for respite care in Requests for admission to a training centers center shall be processed through the CSB providing case management. A parent, guardian, or authorized representative seeking respite care admission to a training center for an individual with an intellectual disability shall apply first to the CSB that serves the area where the individual, or, if the individual is a minor, where the minor's parent or guardian is currently residing. The CSB shall consult with the RST prior to preparing an application for respite care. If the CSB, in consultation with the RST, determines that respite care for the individual is not available in the community, the CSB shall forward an application to a training center serving individuals with intellectual disabilities DBHDS, make a referral to the RST, and follow up on all recommendations made by the RST.

The application shall include:

1. An application for services;

2. A medical history indicating the presence of any current medical problems as well as the presence of any known communicable disease. In all cases, the application shall include any currently prescribed medications as well as any known medication allergies;

3. A social history and current housing or living arrangements;

4. A psychological evaluation that reflects the individual's current functioning;

5. A current individualized education plan for school-aged individuals unless the training center director or designee determines that sufficient information as to the individual's abilities and needs is included in other reports received;

6. A vocational assessment for adults unless the training center director or designee determines that sufficient information as to the individual's abilities and needs is included in other reports received;

7. A statement from the CSB that respite care is not available in the community for the individual;

8. A statement from the CSB that the appropriate arrangements are being made to return the individual to the CSB within the timeframe required under this chapter; and

9. A statement from the individual, a family member, or authorized representative specifically requesting services in the training center.

B. Determination of eligibility for respite care services shall be based upon the following criteria:

1. The individual has a diagnosis of intellectual disability and meets the training center's regular admission criteria;

2. The individual's needs are such that, in the event of a need for temporary care, respite care would not be available in a less restrictive setting; and

3. The training center has appropriate resources to meet the needs of the individual.

By the end of the next working day following receipt of a complete application package, the training center director or the director's designee, in consultation with the assistant commissioner responsible for the training center or the director's designee, shall provide written notice of the director's decision to the CSB. This notice shall state the reasons for the decision.

If it is determined that the individual is not eligible for respite care, the person seeking respite care may ask for reconsideration of the decision by submitting a written request for such reconsideration to the commissioner. Upon receipt of such request, the commissioner or designee shall notify the training center director, and the training center director shall forward the application packet and related information to the commissioner or designee within 48 hours. The commissioner or designee shall provide an opportunity for the person seeking respite care to submit for consideration any additional information or reasons as to why the admission should be approved. The commissioner shall render a written decision on the request for reconsideration within 10 days of the receipt of such request and notify all involved parties. The commissioner's decision shall be binding.

C. Respite care shall be provided in training centers under the following conditions:

1. The length of the respite care stay at the training center shall not exceed the limits established in § 37.2-807 of the Code of Virginia;

2. Space and adequate staff coverage are available on a residential living area with an appropriate peer group for the individual and suitable resources to meet his needs; and

3. The training center has resources to meet the individual's health care needs during the scheduled respite stay as determined by a physical examination performed by the training center's health service personnel at the time of the respite admission.

If for any reason a person admitted for respite care is not discharged at the agreed upon time, the CSB shall develop an updated discharge plan as provided in §§ 37.2-505 and 37.2-837 of the Code of Virginia.

Respite shall not be used as a mechanism to circumvent the voluntary admissions procedures as provided in § 37.2-806 of the Code of Virginia.

12VAC35-200-30. Emergency admission. (Repealed.)

A. In the event of a change in an individual's circumstances necessitating immediate, short-term care for an individual with an intellectual disability, a parent, guardian, or authorized representative may request emergency admission by calling the CSB serving the area where the individual, or in the case of a minor, the minor's parent or guardian resides. Under these circumstances if the CSB, in consultation with the RST, determines that services for the individual are not available in the community, the CSB may request an emergency admission to a training center serving individuals with intellectual disabilities.

The CSB shall make every effort to obtain the same case information required for respite admissions, as described in 12VAC35-200-20 A, before the training center assumes responsibility for the care of the individual in need of emergency services. However, if the information is not available, this requirement may temporarily be waived if, and only if, arrangements have been made for receipt of the required information within 48 hours of the emergency admission.

B. Acceptance for emergency admission shall be based upon the following criteria:

1. A change in the individual's circumstances has occurred requiring immediate alternate arrangements to protect the individual's health and safety;

2. The individual has a diagnosis of an intellectual disability and meets the training center's regular admissions criteria;

3. All other alternate care resources in the community have been explored and found to be unavailable;

4. Space is available on a residential living area with appropriate resources to meet the individual's needs;

5. The training center's health services personnel have determined that the individual's health care needs can be met by the training center's resources; and

6. The length of the emergency stay at the training center shall not exceed the limits established in § 37.2-807 of the Code of Virginia.

C. Within 24 hours of receiving a request for emergency admission, the training center director or the director's designee, in consultation with the assistant commissioner responsible for the training center or his designee, shall inform the CSB whether the individual is eligible for emergency admission and whether the training center is able to provide emergency services.

If the training center is able to provide emergency services, arrangements shall be made to effect the admission as soon as possible.

If the training center is unable to provide emergency services to an eligible individual, the training center director or designee shall provide written notice of this determination to the CSB and may offer in consultation with department staff to try to obtain emergency services from another appropriate facility.

If for any reason a person admitted to a training center for emergency services is not discharged at the agreed upon time, the CSB shall develop a discharge plan as provided in §§ 37.2-505 and 37.2-837 of the Code of Virginia.

12VAC35-200-35. Criteria for admission.

A. Acceptance for admission shall be based upon the following criteria:

1. Receipt of a completed preadmission screening report;

2. The individual has a diagnosis of an intellectual disability made by a licensed professional;

3. All other alternate care resources in the community have been explored and found to be unavailable;

4. Space is available in a residential living area with appropriate resources to meet the individual's needs; and

5. The training center's health services personnel have determined that the individual's health care needs can be met by the training center's resources.

B. If the request is for an emergency admission:

1. There must be documentation of a change in the individual's circumstances requiring immediate alternate arrangements to protect the individual; and

2. The length of the emergency stay at the training center shall not exceed the limits established in § 37.2-807 of the Code of Virginia.

12VAC35-200-45. Application for admission.

A. Application for emergency admission.

1. In the event of a change in circumstances necessitating immediate, short-term care for an individual with an intellectual disability, a parent, guardian, or authorized representative may request emergency admission by contacting the CSB serving the area where the individual or, in the case of a minor, the minor's parent or guardian resides. The CSB shall consult with DBHDS, make a referral to the regional support team (RST), and request an emergency meeting. The CSB shall pursue all recommendations made by the RST. If it is determined that emergency admission is still necessary, the CSB shall consult with the department and request an emergency admission to the training center.

2. The CSB shall make every effort to obtain the information required as described in subdivision 3 of this subsection before the training center assumes responsibility for the care of the individual in need of emergency services.

3. The preadmission screening report requesting emergency admission shall include:

a. An application for services;

b. A medical history indicating the presence of any current medical problems as well as the presence of any known communicable disease. In all cases, the application shall include any currently prescribed medications as well as any known medication allergies;

c. A social history and current housing or living arrangements;

d. A psychological evaluation that reflects the individual's current functioning;

e. A current individualized education plan for school-age individuals, unless the training center director or designee determines that sufficient information as to the individual's abilities and needs is included in other reports received;

f. A vocational assessment for adults, unless the training center director or designee determines that sufficient information as to the individual's abilities and needs is included in other reports received;

g. A statement from the CSB that the appropriate arrangements are being made to discharge the individual to a less restrictive setting within the timeframe required under this chapter; and

h. A statement from the individual, a family member, or authorized representative specifically requesting services in the training center.

4. If the information in subdivision 3 of this subsection is not available, this requirement may be temporarily waived if arrangements have been made for receipt of the required information within 48 hours of the emergency admission.

5. As quickly as possible but no later than 72 hours after receiving a request for emergency admission, the training center director or the director's designee shall inform the CSB whether the individual is eligible for emergency admission and whether the training center is able to provide emergency services.

6. If an emergency admission is appropriate, and the training center is able to provide emergency services, arrangements shall be made to effect the admission as soon as possible.

7. If for any reason a person admitted to a training center for emergency services is not discharged at the agreed upon time, the CSB shall work with the CIM and training center staff to develop a discharge plan as provided in §§ 37.2-505 and 37.2-837 of the Code of Virginia.

8. If an emergency admission is appropriate, and the training center is unable to provide emergency services to an eligible individual, the training center director or the training center director's designee shall provide written notice of this determination to the CSB and may offer, in consultation with department staff, to try to obtain emergency services from another appropriate facility.

B. Application for voluntary admission.

1. Prior to making a request for voluntary admission, the CSB shall consult with DBHDS and make a referral to the RST. The CSB shall pursue all recommendations made by the RST. If it is determined that a voluntary admission is still necessary, the CSB shall consult with the department and request an admission to the training center.

2. If the CSB, after following up on all recommendations made by the RST, determines that the services the individual needs are not available in the community or the individual chooses to obtain services in the state training center, the CSB shall consult with DBHDS and forward an application and a preadmission screening report, pursuant to § 37.2-806 B of the Code of Virginia, to the training center.

3. The preadmission screening report requesting voluntary admission shall include:

a. An application for services;

b. A medical history indicating the presence of any current medical problems as well as the presence of any known communicable disease. In all cases, the application shall include any currently prescribed medications as well as any known medication allergies;

c. A social history and current housing or living arrangements;

d. A psychological evaluation that reflects the individual's current functioning;

e. A current individualized education plan for school-age individuals, unless the training center director or designee determines that sufficient information as to the individual's abilities and needs is included in other reports received;

f. A vocational assessment for adults, unless the training center director or designee determines that sufficient information as to the individual's abilities and needs is included in other reports received;

g. A statement from the CSB that the appropriate arrangements are being made to work with the individual and the family member or authorized representative to continue exploring opportunities to discharge the individual to a less restrictive setting; and

h. A statement from the individual, a family member, or authorized representative specifically requesting services in the training center.

4. Upon the receipt of a completed preadmission screening report, the training center director or the director's designee shall determine eligibility for voluntary admission based upon the admissions criteria.

5. Within 10 business days from the receipt of the completed preadmission screening report, the training center director or designee shall provide to the CSB the written decision on the request for voluntary admission. If the training center director, in consultation with the assistant commissioner responsible for the training center or the assistant commissioner's designee, finds that admission is not appropriate, the training center director shall state the reasons in a written decision and may recommend an alternative location for needed services.

12VAC35-200-50. Requests for reconsideration of the director's determination.

In the event that (i) the CSB making the request for admission or (ii) the parent, guardian, or authorized representative applying on behalf of an individual disagrees with the determination of the director, either party may request a reconsideration of the determination by submitting a request in writing to the commissioner within 10 business days of receiving such determination. Upon receipt of a request for reconsideration, the commissioner shall notify the training center director, and the training center director shall forward the preadmission screening report package and related information to the commissioner within 48 hours. The commissioner shall also provide an opportunity for the individual requesting reconsideration to submit for review any additional information or reasons why the admission should be approved. The commissioner shall render a written decision on the request for reconsideration within 30 calendar days of the receipt of the request and notify all involved parties. The commissioner's decision shall be binding.

12VAC35-200-55. Judicial certification.

Upon receipt of written notification from the training center director that an individual is eligible for voluntary admission, or if the individual will not be discharged within the required timeframe following an emergency admission, the CSB shall inform the individual and the individual's parent, guardian, or authorized representative of this decision and assist the parent, guardian, or authorized representative in initiating a judicial proceeding pursuant to § 37.2-806 of the Code of Virginia. When the judge has certified that the individual is eligible for admission to a training center in accordance with § 37.2-806 F of the Code of Virginia, a date for admission to the training center shall be established.